Contents

Clinical Summary

This 70-year-old man was admitted to the hospital with a history of upper abdominal pain, anorexia, nausea, and general malaise, all of approximately three weeks' duration. His hospital stay was characterized by fever and severe respiratory distress. There were multiple densities in the patient's chest x-ray consistent with pneumoniaIn alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents. and examination of a stained sputum specimen showed acid fast bacilliAcid fast bacilli are not easily decolorized by acid during staining. This is characteristic of mycobacteria.. Despite intensive therapy, the patient progressively deteriorated and died 14 days after admission.

Autopsy Findings

It was determined at autopsy that the patient suffered from pulmonary tuberculosis with widespread dissemination throughout the body. The left lung weighed 620 gramsA normal left lung weighs 375 grams (range: 325 to 480 grams). and the right lung 1230 gramsA normal right lung weighs 450 grams (range: 360 to 570 grams.. These were characterized by marked pulmonary congestionPulmonary congestion is the engorgement of pulmonary vessels with blood. The increased pressure caused by this engorgement leads to transudation of fluid through the capillary walls and into the alveolar and interstitial spaces. and pulmonary edemaPulmonary edema refers to the accumulation of fluid in the pulmonary alveolar and tissue spaces as a result of changes in capillary permeability and/or increases in capillary hydrostatic pressure.. In addition, multiple gray-white nodules ranging from pinpoint size up to 1 cm were diffusely distributed throughout the lung parenchyma.

Images

This is a gross photograph of a cut section of lung from this patient with disseminated tuberculosis. The numerous small white nodules scattered throughout this lung tissue represent individual tuberculosis granulomas. In addition, note the dark areas throughout the lung which represent deposits of anthracotic pigment.

This is a closer view of the same section of lung containing multiple white granulomas which are now more easily identified (arrows). These lesions are referred to as miliary tuberculosis. Dark areas of anthracosis are also prominent in this lung.

This gross photograph shows hilar lymph nodes from another patient with disseminated tuberculosis. The white, cheesy-appearing nodules (arrows) in the lymph nodes give rise to the descriptive terminology of caseous necrosis. The black pigment in the lymph nodes is anthracotic pigment that has drained from the lungs.

This is a low-power photomicrograph of a histology section from the lung of this patient with a chronic history of respiratory disease. Note the multiple eosinophilic nodules (arrows) seen at low power in this section. Other areas of the lung are relatively normal and several bronchi and large vessels can be seen at this low power. The pleural surface of the lung is at the left and the remaining edges are cut edges of the tissue block.

This higher-power photomicrograph of the eosinophilic nodules (arrows) illustrates their discreet nature and the surrounding inflammatory response in the remaining normal lung tissue.

This photomicrograph shows a single nodule with an amorphous eosinophilic center and accumulations of cells around the outer edge. This is typical of a granuloma associated with tuberculosis in which there is a necrotic center (1) and a rim of lymphocytes, macrophages, and occasional multinucleated giant cells around the periphery.

This is a higher-power view of the granuloma with the amorphous eosinophilic material representing caseation necrosis (1), giant cells near the center (2), and inflammatory cells around the periphery.

This is a high-power photomicrograph of Langhans-type multinucleated giant cells (arrows) that are characteristic of tuberculous granulomas. Note the ring of the nuclei in these giant cells.